Question: I’ve read that there is a difference in billing for XEN EX than the traditional placement of XEN 45 that is placed ab interno.  What CPT code do we submit?

Answer: XEN 45 is submitted with Category III code 0449T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach into the subconjunctival space; initial device.

The technique referred to as the XEN-EX is involves going the opposite direction and inserting the device through the conjunctiva first, then through the sclera and then through the angle into the anterior chamber.  Placement of a XEN tube via an external approach (XEN EX) is well-described by CPT code 66183 Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach.  More information can be found at aao.org/MIGS

Learn more about MIGs in the Glaucoma module